Department of General Surgery, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand.
ANZ J Surg. 2023 Dec;93(12):2892-2896. doi: 10.1111/ans.18724. Epub 2023 Oct 2.
Textbook outcome (TO) is an objective, composite measure of clinical outcomes in surgery. TO in liver surgery has been used in previous international studies to define and compare performance across centres. This study aimed to review TO rates following liver resection at a single institution. The secondary aim was to use a CuSum analysis to evaluate monitoring of performance quality over time for colorectal cancer liver metastases (CRCLM).
All patients undergoing liver resection for benign and malignant causes from Christchurch Hospital hepatobiliary unit between 2005 and 2022 were included. Textbook outcomes measures were the absence of; intraoperative incidents, Clavien-Dindo >3 complication, 90 day re-admission, 90 day mortality, R1 resection, and post-operative bile leak/liver failure. Sequential CuSum analysis was performed to review achievement of TO in liver resections for colorectal cancer liver metastases (CRCLM).
Four hundred and seventy-eight patients were included in this study, 54 had resection for benign pathology, 290 for CRCLM and 134 for other malignancies. TO was achieved in 74% of cases overall, with rates for benign, CRCLM and other malignancy being 82%, 73% and 74% respectively (P = 0.405). CuSum analysis documented a deterioration in performance after patient 60, with return to baseline by end of study period.
TO for liver resection in a medium sized centre in New Zealand are comparable to published rates. It is possible to use process control techniques like CuSum with the binary result of TO to monitor performance, providing opportunity for continuous improvement in surgical units.
教科书结局（TO）是手术临床结局的客观综合衡量标准。在以前的国际研究中，肝外科已使用 TO 来定义和比较各中心之间的表现。本研究旨在回顾一家机构的肝切除术的 TO 发生率。次要目的是使用 CuSum 分析来评估随着时间的推移，结直肠癌肝转移（CRCLM）的性能质量监测情况。
纳入 2005 年至 2022 年期间在克赖斯特彻奇医院肝胆科接受肝切除术治疗良性和恶性疾病的所有患者。TO 衡量标准包括：术中无意外、Clavien-Dindo >3 级并发症、90 天再入院、90 天死亡率、R1 切除和术后胆漏/肝功能衰竭。进行序贯 CuSum 分析以评估结直肠癌肝转移（CRCLM）肝切除中达到 TO 的情况。
本研究共纳入 478 例患者，其中 54 例为良性病变，290 例为 CRCLM，134 例为其他恶性肿瘤。总体而言，TO 达到 74%，良性、CRCLM 和其他恶性肿瘤的 TO 率分别为 82%、73%和 74%（P=0.405）。CuSum 分析记录了 60 例患者后性能的恶化，在研究结束时恢复到基线水平。
新西兰一个中等规模中心的肝切除术 TO 与已发表的比率相当。使用 CuSum 等过程控制技术，以 TO 的二进制结果来监测性能是可能的，为外科单位的持续改进提供了机会。
